Type 2 Nutrition #443: The 1-percenters

A while back, on a nutrition website intended for the cognoscenti, I watched a TED talk that a member had recommended. The talk was said to “help you find your ideal diet,” a “personalized program just for you.” It turned out to just be a businessman’s pitch for his startup’s service to design an “individualized” diet for you, for a fee. It was a sham, designed to appeal to a nutritionally naïve audience. Of course, this would include 99% of the public, but I expected better from this nutrition site and especially from its leaders.

People who are unable or unwilling to accept the radical changes that are necessary to make a major “lifestyle change” usually resort to the meme that “everyone is different.” That’s a convenient scapegoat. The truth is we are all human and our biological processes for digesting and absorbing the basic components of food –protein, fat and carbohydrates – are virtually identical. The only differences are the degree that a bundle of glucogenic genes have to a lesser or greater extent been “modified,” over time, by overindulging unnaturally in a diet composed of a very high percentage of processed carbs. That will vary from person to person.

These “over-indulgers” develop a dysfunctional glucose metabolism. Once “modified,” these genes continue to express this Carbohydrate Intolerance on a continuum. It is a path which will lead most people, over a period of many years, to develop type 2 diabetes and become obese. The condition is called Insulin Resistance.

Insulin Resistance is thus a genetic expression of a bundle of genes, in those genetically predisposed, such that the insulin receptors on cells that ordinarily open up to allow glucose energy to enter and nourish them, no longer function properly. When these insulin receptor cells “resist,” and the uptake of glucose is impaired, the pancreas secretes more insulin to help out. Type 2 diabetes is thus a disease of too much INSULIN in the blood stream. Characteristically, type 2s have both elevated blood glucose and elevated blood insulin.

The elevated blood glucose is what clinicians use to detect the presence of incipient pre-diabetes or frank type 2 diabetes. Today the hemoglobin A1c (HbA1c) is the blood test used to make this diagnosis. Previously, an elevated fasting blood glucose (FBG) was used. The gold standard, however, still used by endocrinologists, is the Oral Glucose Tolerance Test (OGTT). It takes 2 hours and is more expensive, but nevertheless the best.

The elevated blood INSULIN is what causes obesity (in about 80% of type 2s). While insulin is elevated in the blood stream, to avert hunger the body must rely on food by mouth for energy. Most people eat carbs at every meal and often between meals. The net result is that we are always hungry and then, when we eat more and more often, we get fat. So, with INSULIN RESISTANCE, your blood INSULIN stays high. It’s only when your BLOOD INSULIN level drops that the liver looks for an alternate energy source and turns to breaking down body fat (the food you’ve already eaten) for energy.

The 1-percenters know this. But knowing it and doing something about it are very different. It is hard to change one’s lifestyle and in particular one’s eating habits, which are both cultural and very personal. Incipient pre-diabetes and frank type 2 diabetes are symptomless conditions.  And it takes decades to kill us, most often indirectly by heart attack, stroke, or Alzheimer’s (aka type 3 diabetes) and many cancers. These days, with better care, blindness, amputation and end-stage kidney disease are less common morbidities.

So, what’s the best motivator to make a “lifestyle change”? Well, how would you like to “kill two birds with one stone”? Lose lots of weight and reverse your slow slide into full-blown type 2 diabetes? You can, but you will either have to eat Very Low Carb most of the time, or fast for a day or two a week, or both. That’s what I did. I started eating Very Low Carb in 2002 and lost 170 pounds. When I plateaued a few times and gained some back, I added fasting. I lost 60+ pounds. I maintain my weight by eating Very Low Carb and fasting.

Type 2 Nutrition #442: Stepping into my new trousers…

About 6 months ago I took several pairs of trousers to a local tailor to have them altered. In the previous 6 months I’d lost a lot of weight (60+ pounds), and there were very few pants in my closet that didn’t bunch up at the waist when I cinched them in. The tailor took a look and told me the truth. “I can take them in,” she said, “but you’ll always have a big baggy seat. You really should buy some new pants.” So, that’s what I did.

My wife cautioned me not to rush into it though. She said, “Buy one pair to see how it fits. Then you’ll know what size to order going forward.” That sounded prudent. But first, so there would be no going back, I went through all my clothes in the closet and the bureau and prepared to take them to the church thrift shop and the Salvation Army. With last year’s tax reform, who knows if I will ever have a chance to deduct them again!

Then I took a bold step: I ordered a pair of trousers with a waist size smaller than I have bought in over half a century. Fact is, I have no idea when I last ordered pants that small. I had nothing in my closet or bureau that small and some of the clothes there were ancient! So, I placed the order and anxiously awaited its arrival.

In the meantime I tried on a few sports jackets. One was a Mageehandwoven Irish tweed that I bought in ’04 in Donegal and had worn only a few times. It was much too large. Then I found another tweed that I bought at Harrods in London in 1969 and that now fit perfectly! It had been relined ages ago and still looks great!

Then I went through my bureau and found a few things that now fit that I hadn’t worn in maybe 40 years. I also found a few things that I had neverworn and that now would never fit. They were much too large.

Finally I went to the front hall closet where we keep our winter clothes. A Woolrich heavy winter car coat that I had hardly ever worn was much too big, but my favorite, a 50-year old, cherry-red ski parka now fit perfectly.

The exercise of “cleaning house” was cathartic. It brought back many fond memories of times and places that I have been and things I have done: shorts and knit shirts from a long ago vacation in Bermuda, an embroidered knit shirt that my brother gave me when I skippered his 45-foot Bristol sailboat for a week. I took my wife and her 3 daughters and their husbands for a sail out in the Bahamas. And the 2-week golf vacation to Ireland, with the “Fat Boys,” where we played 12 rounds in 12 days, more than 1 in the rain without a cart. 

And all the tee shirts from everywhere, especially those that I wore when I fished for 12 years from my kayak in the ocean and in the Indian River in Florida. Everything that no longer fit went to the thrift shop or the Salvation Army bin. It was very “Jungian” to clear out the past with an eye to “making room” for the future. 

I was also eager to secure the weight loss in my mind and close this “fat period” from my past. I decided I wasn’t going to take out any “insurance policy” that the weight loss would be temporary and that one day I might regain the weight that I had lost. I was confident that once “there,” my weight loss would now be permanent. And I was confident that I knew how to do it, and that I would put that knowledge into practice.

This step may have been the boldest of all. Most people who lose a lot of weight, including me, have put some of it back on. But I knew now that I had found the secret: Very Low Carb all the time, mostly 1-meal a day (OMAD), and 1 or 2 300kcal/full day fasts each week (as needed) to keep my weight within a 3-4 pound range.

A few days later the box with the trousers arrived and, with great anticipation, I opened it.  I removed them and took them out of the plastic bag. I then “stood them up,” opened the waist and held them in front of me with both hands, as though I was preparing to step into them. And…the “hole,” into which I imagined I would step – right leg first – was TINY!How would I…how could I step into such a SMALL OPENING! I smiled to myself as I came to this realization. If I was going to step into my new trousers successfully, it was going to take a little practice. I would have to focus on it – pay full attention. At my age I can’t afford to break a leg or a hip!

Type 2 Nutrition #441: Have I cured my type 2 diabetes?

“You’re cured,” the clinician told me. “You no longer have type 2 diabetes.” You’d think I would greet this news with a sigh of relief since I was diagnosed 32 years ago; but I did not, because I didn’t believe it.

I was not, however, surprised with that doctor’s response. I had just told her that, because I changed my Way of Eating (WOE), my A1c was now 5.0% and my average FBG in the mid-80s. From the clinician’s point of view, as one who treats patients according to the ADA’s Standards of Medical Care, her goal would be to manage my diabetes to get my A1c to ≤7.0%, or even ≤6.5%, the diabetes threshold. Thus to her, clinically speaking, I am “cured.” I asked her, “Would you then write on my chart that I no longer have diabetes?” She replied, “Yes.”

When I shook my head in dismay, she asked me why I wouldn’t accept this “good news.” I replied, “Because I will always have Insulin Resistance and therefore will always be diabetic.”  She just smirked, not wishing to get into an argument. We were, after all, just chatting in a social setting after a panel discussion in NYC with Gary Taubes. Nevertheless, she said dismissively, and with authority, that what I said was untrue. I left it at that. The divide between us was too great. In her view, unlettered dotards like me shouldn’t be taken seriously.

This doctor wasn’t my doctor and wasn’t going to be. Except for my MD friends who read this blog – and there are a few – I leave the one-on-one re-education of the trained professional to others. But, as the Heal Clinic's Dr. Eric Westman sadly said to me recently (in #402 here), “Ignorance is the biggest problem. Gary Taubes expressed a corollary sentiment to me that night. He said the Low Carb “movement” has increased 100 fold in just a few years from 1/100^th percent to 1 percent. That’s a huge relative improvement…yet still an abysmal state of affairs. There is yet so much work to be done to overcome the entrenched positions in the political, agribusiness, big pharma, public health, medical, and other special interest establishments.

But I digress. Insulin Resistance is a genetic expression of a bundle of genes, in those genetically predisposed, such that the insulin receptors on cells that ordinarily open to allow glucose energy to enter and nourish them, no longer function properly. When these insulin receptor cells “resist,” and the uptake of glucose is impaired, the pancreas secretes more insulin to help out. Type 2 diabetes is thus a disease of too much insulin in the blood stream. Characteristically, type 2s have both an elevated blood glucose and an elevated blood insulin.

The elevated blood glucose is what clinicians use to detect the presence of incipient pre-diabetes or type 2 diabetes. Today the hemoglobin A1c (HbA1c) blood test is used for diagnosis. Previously, an elevated fasting blood glucose (FBG) was used. The gold standard, still used by endocrinologists, is the Oral Glucose Tolerance Test (OGTT). It takes at least 2 hours and is thus more expensive. It is, nevertheless, still the best. The easiest test is to measure your waist/hip ratio; anything over 1.0 (male) or .8 (female) signals insulin resistance.

The elevated blood INSULIN  causes obesity. While insulin is elevated, the body must rely on food by mouth for energy. Most people eat carbs in every meal and frequently between meals. So, if you have a little Insulin Resistance, your blood INSULIN level stays high. That’s why we are always hungry and why, when we eat more and more often, we get fat. Only when your blood INSULIN level drops will  the liver look for an alternate energy source and turn to breaking down body fat for energy. But to do this, a person either must eat VERY LOW CARB most of the time, or FAST for a day or two, or BOTH.

So, while I have no clinical signs of type 2 diabetes, and a doctor may regard me as “cured,” I know that I am still Insulin Resistant. I know that it is only because I eat Very Low Carb most of the time, and fast a few days most weeks, that my Insulin Resistance is not expressed. But my Insulin Resistance will always be there, and that is why I will always be a type 2 diabetic – a (thin) type 2 in remission, but only because of the way I eat.

Type 2 Nutrition #440: The Drinking Man’s Liquid Fasting Diet

As a drinking man, this post is my approach to eating, drinking and fasting. Last week’s, Type 2 Nutrition #439, describes the original 1964, “The Drinking Man's Diet.” The premise of both is that, as Robert Cameron wrote in 1964, “Most everyone has a drink now and then.” My contention is that it is not necessary, when either dieting or fasting to give up alcohol completely. This should allay the fear, or excuse, for not trying it.

In this 2004 Forbes Magazine piece, commemorating the 40^th anniversary of its original publication, Cameron was described as a bon vivant. It’s hard to know at this point whether he was or not, but his little pamphlet is replete with humorous references to various spirits in conjunction with the “high-life.” Reading it today it sounds more like a parody of the ‘50s, but in context, it could very well have been the way some people lived.

In any case, while today’s business man or woman no longer indulges in a 2-martini lunch, it is fair to say that “most (sic) everyone has a drink now and then,” many at home before or with dinner. It has been justified, or rationalized, as a way to relax and relieve stress. There’s a social aspect to it: a chance to sit down with one’s spouse and “communicate” (LOL). As a result, perhaps based on today’s mores, medical advice websites tout the “health benefits” of “light drinking,” usually defined as 1 alcoholic drink per day for women and 2 for men.

Okay, so that’s my set-up. I like a drink. I consider myself a light drinker, fitting the guideline above. I drink spirits (scotch, bourbon, vodka, etc) on special occasions. We go out for dinner on average once a week. In a restaurant I will often have one or sometimes two cocktails, depending on the bartender (the amount of the “pour”). We entertain at home much less often these days, but if we have people over for dinner, I will make just one for me and any guests who will join me. When I make the drink, one is always enough. LOL

On a daily basis, I drink wine at home. When I am NOT fasting, my Way of Eating is generally to eat Very Low Carb: to have just coffee with cream for breakfast, to have, if any, a very light lunch – usually a can of kippered herring – and then to have a small supper. Supper is a portion of protein with a low-glycemic vegetable, either roasted in olive oil or tossed in butter, or a salad. Daily food intake is about 1,200 kcal: 100g fat, 60g protein, and 15g carbs. In addition, I have two 5-ounce pours of red wine, the glass then filled with seltzer: a “spritzer.”

I describe my non-fasting daily eating routine as Very Low Carb, One Meal a Day, or VLC/OMAD. When I am “fasting,” I have the same “breakfast,” I skip lunch, and for “supper” I have just one red-wine spritzer.

If I am working at “hard labor” (in the garden), I will drink diet ice tea sweetened with liquid stevia. For electrolyte balance, I will supplement it with pickle juice, or a large cup of bouillon.  For any oral fixation impulses, especially after supper, I will make a “cocktail” of 1 Tbs of Bragg’s Apple Cider Vinegar (ACV), a few dashes of bitters, and 5 drops of liquid stevia, stirred (not shaken), the glass filled with ice and then seltzer.

The ACV cocktail is satisfying and is said to be good for blood glucose control too. Who knows? I’ve been a type 2 for 32 years and my A1c is now 5.0%, so I would say that I have my “progressive” disease under control. I do it with just a Very Low Carb diet, intermittent fasting, red wine and Metformin (750mg twice a day).

My “Drinking Man’s Liquid Fasting Diet” is about 300 kcal/day, equally divided between “breakfast” and “supper.” Macronutrient Distribution is detailed in Type 2 Nutrition #410. It is Protein: 1.2g; Fat: 16g; Carbs: 5.7g and ethyl alcohol: 18g. Last year, I lost about 60 pounds following this “Liquid Fasting Diet.”

I have been losing weight eating Very Low Carb since 2002. I weighed 375 pounds at the start and twice got down to 205, then stalled and regained some. In early 2017 I started my “Liquid Fasting Diet” to break the log jam. It was not a “water-only” fast, though. It was this “Drinking Man’s Liquid Fasting Diet,” as described. I generally ate 4 days and fasted 3 days a week. So, this would make my WOE a VLC/OMAD/4-3 DIET. Cheers!

Type 2 Nutrition #439: “The Drinking Man’s Diet”

Everyone of a certain age has heard of “The Drinking Man's Diet.” But what do you know about it? I asked a friend recently if she knew what kind of diet it was. She shrugged and said something like, “It’s a diet in which you drink alcohol?” I said I thought so too, but we both missed the gist of it. It was the first (modern) low carb diet!!! And at 60 grams of “carbos” a day, it was pretty low carb! It might even be called a Very Low Carb diet.

First published in 1964, in 2 years “The Drinking Man’s Diet” sold 2.4 million copies at $1 apiece.  On the jacket of the 50^th Anniversary Edition, it proudly proclaims, “THE ORIGINAL LOW-CARB DIET.” The subtitle is, “HOW TO LOSE WEIGHT WITH A MINIMUM OF WILLPOWER.” These are still both accurate claims!

On the occasion of the publication of the 40^th anniversary edition (2004), Forbes Magazine did a column on the book and its author, Robert Cameron. Forbes described Cameron (who wrote using a nom de plume), as a San Francisco bon vivant whose brilliant title explains the book’s success, as well as how we were misled by it. The drinking aspect of the contents and title was just a gimmick. The diet works just as well for “teetotalers.”

The following quotes are taken from “The Drinking Man’s Diet,” 50^th Anniversary Edition:

“This really is a simple diet. It can be summed up in one sentence: Eat no more than 60 grams of carbohydrates a day. That’s all there is to it.”

So what is a carbohydrate? As you will learn in this book, “Carbohydrates are concentrated in starches and sugars. They are almost absent from hearty foods like meat, fish, poultry, cheese and salads (yes, even the usually forbidden salad with Roquefort dressing is okay.)”

“Now, is it hard to count grams of carbohydrates? No, with the aid of tables at the back of this book you will find it very easy. The tables are derived from publication (sic) of the U. S. Department of Agriculture.”

“What makes this kind of counting more enjoyable as well as easier than calorie counting is that most of the things you like best don’t have to be counted at all: steak and whiskey, chicken and gin, ham, caviar, paté de foie gras, rum and roast pheasant, veal cutlets and vodka, frog’s legs and lobster claws, all count as zero.”

“Remember, you must count everything. A few innocent-looking dates or raisins in the afternoon can fill up your quota for the day. A slice or two of French bread might make your daily carbohydrate ration, but half a dozen slices would be a disaster. But with the great bulk of your diet – the meat and fish, the eggs and fats – counting at very close to zero, you really shouldn’t have much trouble keeping the total down around sixty.”

The Forbes piece recounts how Dr. Frederick Stare, who in 1942 founded Harvard’s School of Public Health, had decried Cameron’s diet as unhealthful –calling it “mass murder,” which he later retracted. The accusation, however, ran everywhere on Page 1 and, as Forbes quipped, “…the drinking man’s goose was cooked.”

Robert Cameron wrote this pamphlet nine years before Dr. Robert Atkins’s (in)famous, “The Diet Revolution.” Atkins faced similar charges from the public health establishment. The American Medical Association, in public testimony at a congressional hearing, ridiculed and humiliated him, calling his diet “a dangerous fraud.”

But the diet worked. In two months, Cameron says he lost 18 pounds, “…was never hungry, and never missed a martini.” Cameron wrote, “Most everyone has a drink now and then,” and “alcoholic beverages such as gin, whiskey and vodka do not contain carbohydrates. Therefore, it allowed them to lose weight without giving up a daily cocktail.” Thus his 1964 pitch: “Did you ever hear of a diet that was fun to follow? A diet that would let you have two martinis before lunch (how 1960s!), and a thick steak generously spread with Sauce Béarnaise?”

The carb tables in this book, like the word “carbo,” are dated and unreliable, but the principles are still good.